Featured Services
Safe neighborhoods
Warm loving families
A private bedroom
Internet Access
A shared bathroom
Two meals daily
New! Homestay
Immersion Program!


Contact Us
848 North Shore Road
Revere, Mass. 02151
Phone: 781-307-3039
Fax: 617-728-4299
E-Mail:
WelcometoAmericahomestay
@gmail.com
 
Parent application Form

Welcome to America Homestay
848 North Shore Road
Revere, Mass. 02151
781-307-3039


* Required Field
Date(yyyy-mm-dd):
*
Last Name :
*
First Name :
*
Partner’s Name :
*
Address:
*
City:
*
MA Zip Code:
*
E-Mail:
*
Cell:
*
Partner’s cell:
List one relative or friend in case of emergency::
Name:
Phone:
Relation:
Child's Name: Age Sex Birthdate mm/dd/yy Living at home?
List other people living with you: (include Name, Sex, Age and Relationship)
Do all of the members of your household agree to host a student? Yes No
Why do you wish to host a student?
 
Occupation :
Partner's Occupation :
Name of Company:
Name of Company(partner):
Work Phone:
Work Phone(Partner):
Work Days/Hours:
Work Days/Hours(Partner):
Employment Verification Phone:
Partner's Employment Verification Phone:
 
List Two Personal References (Not Relatives)
Name:
Address:
City:
State:
Zip:
Phone :
Work Phone :
   
Name:
Address:
City:
State:
Zip:
Phone :
Work Phone :
 
Homestay Family Application
Language spoken at home:
Second Language:
What other countries have you visited?:
Have you hosted a student before?:
What Nationality?:
How many students do you wish to host at one time?:
(Each student must have a separate room with a window, door, bed, dresser, closet, desk, chair and proper light for studying)
Do you prefer:
Male Female Either
Countries:
May students put in a private phone?:
Yes No (students pay their long distance charges)
Will students have access to wireless Internet?:
Yes No or a computer with Internet?
Do you have a washer/dryer in your home?:
Yes No
Do you have pets?:
Dogs Cats Other Inside Outside
Do you smoke?:
Frequent Seldon Never
Have you or any member of your family been convicted of a criminal offense?:
Yes No
Would you allow smoking?:
Yes No if no, would you allow smoking outside?
Do you drink alcoholic beverages?:
Frequent Seldon Never
Do you object to students (over 21) drinking?:
Yes No
Do you mind students using the kitchen?:
Yes No
Transportation: Please check with the MBTA for the time between your front door and downtown Boston. Including walking, riding, and waiting for transfers it should be less than 45 minutes.
Please write down the Public Transportation route from your house to downtown Boston
What time is the last bus/train to return to your home?:
Weeknights Weekends
 
Hobbies and Activities:
Do you have a musical instrument in your house?:

Yes No

What Kind?:
Does your family prefer activities at home or away from home?:
Please check the activities that your family enjoys. List choices and the family member that participates:
Sports Miscellaneous Family Activities
 
Please add anything else that you think would help us to select the right student for you
 
Who may we thank for referring you to our program?:
I confirm that the foregoing information is true, and that I wish to be a Host Family.
Signature of applicant Date 1:
   
Signature of applicant Date 2: